Long-term results of less-invasive surgery unknown

Dr. Anthony Komaroff

NEA / United Media

By Dr. Anthony Komaroff / NEA/United Media

Published: Monday, January 21, 2013 at 03:32 PM.

Dear Doctor K: I have aortic valve regurgitation and need to have my aortic valve replaced. What will happen during this procedure?Dear Reader: When it’s working properly, your aortic valve opens to allow oxygen-rich blood to flow from your heart into your aorta and out to the rest of your body. The aorta is the body’s largest blood vessel. (I’ve put an illustration of how healthy heart valves work on my website, AskDoctorK.com.) Heart valves keep blood flowing in just one direction — the direction the heart wants to pump blood. Particularly when you’re sitting or standing up, gravity wants to pull blood back down into the heart from the aorta. If that happened, the heart would have to work much harder: It would keep having to pump the same blood out into the circulation. A healthy aortic valve prevents gravity from pulling blood back down into the heart. Aging and disease can damage the aortic valve. If it doesn’t close tightly, blood can re-enter the heart, causing aortic regurgitation. It can cause fatigue, shortness of breath, fainting and other symptoms. If your symptoms are severe, or if the condition is weakening your heart, you may need to have your aortic valve replaced with a prosthetic valve. Prosthetic valves are either synthetic mechanical valves or biological valves made of human or animal tissue. The traditional surgery involves splitting the breast bone, exposing the heart and then replacing the valve. An intravenous (IV) line is inserted into your arm to deliver fluids and medications. You will be given a general anesthetic. After your heart is exposed, your heart will be cooled and stopped while the surgery is being performed. That’s because it’s hard to perform surgery on a beating heart. Since your heart has stopped, you need a machine — a heart-lung machine — to get oxygen in your blood and pump it around the body. Once your heart is motionless, the surgeon will cut through its muscular wall. He or she will remove the malfunctioning heart valve, insert the prosthetic valve and stitch it into place. After closing the incision in your heart wall, the surgeon will warm your heart. Once your heart is pumping steadily without leaking blood, you will be disconnected from the heart-lung machine. The surgeon will reattach the halves of your breastbone and your chest incision will be closed. For some patients, the heart surgeon can replace a heart valve through a smaller incision. New technologies allow artificial valves to be inserted into the heart without making even a small opening in the patient’s chest. Heart specialists are still gaining experience with these less-invasive approaches. There is little doubt that, because they involve cutting into fewer tissues, patients heal more quickly. However, it’s not yet clear if the long-term results of less-invasive types of surgery are as good as with traditional surgery.

Dear Doctor K: I have aortic valve regurgitation and need to have my aortic valve replaced. What will happen during this procedure?Dear Reader: When it’s working properly, your aortic valve opens to allow oxygen-rich blood to flow from your heart into your aorta and out to the rest of your body. The aorta is the body’s largest blood vessel. (I’ve put an illustration of how healthy heart valves work on my website, AskDoctorK.com.)
Heart valves keep blood flowing in just one direction — the direction the heart wants to pump blood. Particularly when you’re sitting or standing up, gravity wants to pull blood back down into the heart from the aorta.
If that happened, the heart would have to work much harder: It would keep having to pump the same blood out into the circulation. A healthy aortic valve prevents gravity from pulling blood back down into the heart.
Aging and disease can damage the aortic valve. If it doesn’t close tightly, blood can re-enter the heart, causing aortic regurgitation. It can cause fatigue, shortness of breath, fainting and other symptoms.
If your symptoms are severe, or if the condition is weakening your heart, you may need to have your aortic valve replaced with a prosthetic valve. Prosthetic valves are either synthetic mechanical valves or biological valves made of human or animal tissue.
The traditional surgery involves splitting the breast bone, exposing the heart and then replacing the valve. An intravenous (IV) line is inserted into your arm to deliver fluids and medications. You will be given a general anesthetic.
After your heart is exposed, your heart will be cooled and stopped while the surgery is being performed. That’s because it’s hard to perform surgery on a beating heart. Since your heart has stopped, you need a machine — a heart-lung machine — to get oxygen in your blood and pump it around the body.
Once your heart is motionless, the surgeon will cut through its muscular wall. He or she will remove the malfunctioning heart valve, insert the prosthetic valve and stitch it into place.
After closing the incision in your heart wall, the surgeon will warm your heart. Once your heart is pumping steadily without leaking blood, you will be disconnected from the heart-lung machine. The surgeon will reattach the halves of your breastbone and your chest incision will be closed.
For some patients, the heart surgeon can replace a heart valve through a smaller incision. New technologies allow artificial valves to be inserted into the heart without making even a small opening in the patient’s chest.
Heart specialists are still gaining experience with these less-invasive approaches. There is little doubt that, because they involve cutting into fewer tissues, patients heal more quickly. However, it’s not yet clear if the long-term results of less-invasive types of surgery are as good as with traditional surgery.